Healthcare Provider Details

I. General information

NPI: 1912280074
Provider Name (Legal Business Name): ANITA JOY SZATKOWSKI PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANITA JOY HYMES PAC

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13700 ST FRANCIS BLVD EMERGENCY MEDICINE DEPARTMENT
MIDLOTHIAN VA
23114-3222
US

IV. Provider business mailing address

38935 ANN ARBOR RD CREDENTIALING/PAYER CONTRACTING
LIVONIA MI
48150-3397
US

V. Phone/Fax

Practice location:
  • Phone: 804-594-7950
  • Fax: 804-594-7955
Mailing address:
  • Phone: 734-632-0175
  • Fax: 734-632-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110840425
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: